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Patient-specific surgical planning and hemodynamic computational fluid dynamics optimization through free-form haptic anatomy editing tool (SURGEM)

Abstract

The first version of an anatomy editing/surgical planning tool (SURGEM) targeting anatomical complexity and patient-specific computational fluid dynamics (CFD) analysis is presented. Novel three-dimensional (3D) shape editing concepts and human–shape interaction technologies have been integrated to facilitate interactive surgical morphology alterations, grid generation and CFD analysis. In order to implement “manual hemodynamic optimization” at the surgery planning phase for patients with congenital heart defects, these tools are applied to design and evaluate possible modifications of patient-specific anatomies. In this context, anatomies involve complex geometric topologies and tortuous 3D blood flow pathways with multiple inlets and outlets. These tools make it possible to freely deform the lumen surface and to bend and position baffles through real-time, direct manipulation of the 3D models with both hands, thus eliminating the tedious and time-consuming phase of entering the desired geometry using traditional computer-aided design (CAD) systems. The 3D models of the modified anatomies are seamlessly exported and meshed for patient-specific CFD analysis. Free-formed anatomical modifications are quantified using an in-house skeletization based cross-sectional geometry analysis tool. Hemodynamic performance of the systematically modified anatomies is compared with the original anatomy using CFD. CFD results showed the relative importance of the various surgically created features such as pouch size, vena cave to pulmonary artery (PA) flare and PA stenosis. An interactive surgical-patch size estimator is also introduced. The combined design/analysis cycle time is used for comparing and optimizing surgical plans and improvements are tabulated. The reduced cost of patient-specific shape design and analysis process, made it possible to envision large clinical studies to assess the validity of predictive patient-specific CFD simulations. In this paper, model anatomical design studies are performed on a total of eight different complex patient specific anatomies. Using SURGEM, more than 30 new anatomical designs (or candidate configurations) are created, and the corresponding user times presented. CFD performances for eight of these candidate configurations are also presented.

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Acknowledgments

Drs. Mark Fogel, William Gaynor at the Children’s Hospital of Philadelphia, Dr. Pedro del Nido, Boston Children’s Hospital, Paul Krishborn-Emory University and Dr. W. James Parks at Sibley Heart Center, Egleston Children’s Hospital/Emory University, Atlanta. We also thank Hiroumi Kitajima and undergraduate student Gopinath Jayaprakash for providing most of the reconstructions used in this study. Also Paymon Nourparvar and Vasu Yerneni assisted in the CFD simulations through Georgia Tech President’s Undergraduate Research Awards (PURA). Financial support: National Heart, Lung and Blood Institute Grant HL67622 and Seed Grant from the Graphics Visualization and Usability (GVU) Center at Georgia Tech.

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Correspondence to Kerem Pekkan.

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Pekkan, K., Whited, B., Kanter, K. et al. Patient-specific surgical planning and hemodynamic computational fluid dynamics optimization through free-form haptic anatomy editing tool (SURGEM). Med Biol Eng Comput 46, 1139–1152 (2008) doi:10.1007/s11517-008-0377-0

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Keywords

  • Patient specific surgical planning
  • Computational fluid dynamics
  • Congenital heart defects
  • Computer aided design